Nicole Langan Maciejak, APRN

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

3454 Issued in CT

Practice address

35 Davis Street
SBHC
New Haven, CT 06515-1601

Phone

(475) 220-7815

Fax

(475) 220-7842

NPI assigned

Nov 13, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Nicole Patrice Langan Former name

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nicole.langan-maciejak@ctproviderdirect.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cornell Scott Hill Health Corporation

  • Federally Qualified Health Center (FQHC)
  • New Haven, CT
  • NPI 1902921380
  Medicare reassignment NPD
• Cornell Scott Hill Health Corporation

  • Multi-Specialty Clinic/Center
  • New Haven, CT
  • NPI 1962477968
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573603200000",
    "number": "1174694798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 HEMPSTEAD ST",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063206204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 DAVIS STREET",
            "address_2": "SBHC",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065151601",
            "telephone_number": "475-220-7815",
            "fax_number": "475-220-7842"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "305 Broadway",
            "address_purpose": "LOCATION",
            "city": "Norwich",
            "state": "CT",
            "postal_code": "063603547",
            "country_code": "US",
            "telephone_number": "860-204-0442",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACIEJAK",
        "first_name": "NICOLE",
        "middle_name": "LANGAN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2019-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CT",
            "license": "3454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004271821",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "LANGAN",
            "middle_name": "PATRICE",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Margaret Anne Macgibeny, MD, PHD
• Justin Richard Macgregor, LPC
• Marc Machaalani, MD
• Francisco Javier Machiavello Roman, MD
• Anthony Javed Machikan, MBBCH
• Jessica Ariel Mack, APRN
• Zoe Patricia Mackay, MD
• Laura Katherine Mackie
• Jelena Goldoni Macleod, MD, MHS
• Laurie K Macleod, CNM

• Pediatric Nurse Practitioner in New Haven, CT
• Providers in New Haven, CT by specialty
• Pediatric Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.